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Blue Cross Medicare Advantage Core (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Core (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Cross Medicare Advantage Core (PPO) in 2025, please refer to our full plan details page.
Blue Cross Medicare Advantage Core (PPO) is a PPO plan offered by Aware Integrated, Inc. available for enrollment in 2025 to people living in 51 County Region. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Blue Cross Medicare Advantage Core (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Blue Cross Medicare Advantage Core (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Blue Cross Medicare Advantage Core (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $5.80. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $350.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $7900.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $7900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Blue Cross Medicare Advantage Core (PPO) plan has a $350 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and the pharmacy you use. For example, in the initial coverage phase, you may pay no copay or a $5 copay for preferred generic drugs, while standard generic drugs have a 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Blue Cross Medicare Advantage Core (PPO) plan offers a range of benefits, including coverage for inpatient hospital stays with a $300 copay for days 1-5, and no copay for days 6-90. Outpatient services have varying copays, and there are copays for services like ambulance, emergency, and primary care visits. Additional benefits include preventive, hearing, vision, and dental services, with specific copays or maximum benefits. The plan also covers home health services with no copay, and skilled nursing facility stays with no copay for days 1-20, and a $214 copay for days 21-100. Other covered services include acupuncture and over-the-counter items up to $60 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, there is a $300 copay for days 1-5, and no copay for days 6-90, while Inpatient Hospital Psychiatric has a $300 copay for days 1-5, and no copay for days 6-90; additional days and non-Medicare-covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay of $20.00 - $350.00, observation services with a copay of $350.00, ambulatory surgical center (ASC) services with a copay of $300.00, outpatient substance abuse services with a copay of $20.00, and outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Cross Medicare Advantage Core (PPO) plan with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Cross Medicare Advantage Core (PPO) plan. Ground and Air Ambulance Services each have a $290 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Blue Cross Medicare Advantage Core (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $45 copay, while Worldwide Emergency Services has a $125 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a 20% coinsurance for Worldwide Emergency Transportation.
Primary Care See details
The Blue Cross Medicare Advantage Core (PPO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, and physician specialist services with a $40 copay. The plan also covers mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits, and opioid treatment program services with a $40 copay.
Preventive Services See details
Preventive Services include coverage for services such as health education, glaucoma screenings, and counseling services. In-Home Safety Assessments, Personal Emergency Response Systems, Medical Nutrition Therapy, and other services are not covered.
Hearing Services See details
Hearing services include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams are covered for 2 visits every year. Prescription hearing aids (all types) are covered with a copay between $699 and $999 every year, while prescription hearing aids (inner ear, outer ear, and over the ear) are not covered.
Vision Services See details
Vision Services includes coverage for routine eye exams, with two visits per year, and eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames. Eyewear has a combined maximum benefit of $275.00 every year, and upgrades are not covered.
Dental Services See details
The Blue Cross Medicare Advantage Core (PPO) plan provides dental coverage, including a $50 copay for Medicare Dental Services. Other dental services have a maximum benefit of $2000 per year, including Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), and Fluoride Treatment; however, Restorative Services, Endodontics, Prosthodontics, Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Blue Cross Medicare Advantage Core (PPO) plan, which includes coverage for Medicare Part B Insulin Drugs with a copay between $0 and $35, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the Blue Cross Medicare Advantage Core (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered by the Blue Cross Medicare Advantage Core (PPO) plan, with Durable Medical Equipment (DME) subject to a 20% to 35% coinsurance, and authorization is required. Prosthetics/Medical Supplies have no copay, with coinsurance applying to Medicare-covered devices and supplies, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, while Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and outpatient X-ray services, with a copay of up to $25 for diagnostic procedures and $15 for outpatient X-rays. Therapeutic Radiological Services are covered with a coinsurance of 20%. Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the Blue Cross Medicare Advantage Core (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. The plan requires prior authorization for cardiac rehabilitation services, and the copay information is described elsewhere.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Cross Medicare Advantage Core (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day.
Other Services See details
Under the Blue Cross Medicare Advantage Core (PPO) plan, acupuncture has a $20 copay, and over-the-counter items are covered up to $60 every three months. Meal benefits are also covered for chronic illnesses. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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